2.15.2008

sara robinson: canadian health care myths debunked

Sara Robinson, perhaps best known from the blog Orcinus, has written an excellent piece on Campaign for America's Future, debunking myths about the Canadian health care system.

Sara has taken the time for something few people in this debate ever bother with: nuance. It's well worth reading. The comments - along with Sara's responses - are worthwhile, too, sometimes for facts, and sometimes for fallacies.
2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning -- and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.

I'm both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I'm in a unique position to address the pros and cons of both systems first-hand. If we're going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.

To that end, here's the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they're made of. [Continue here.]

I admire groups working for change in the US. I know how frustrating it can be, and I admire their willingness to fight against the tsunami-strength current.

Thanks to James for sending.

34 comments:

Scott M. said...

I am a staunch supporter of the Canadian system, but I do find that most of the defenders of the system, such as Sara Robinson, intentionally play down the problems with the system and make the system out to be much better than it is.

A great example is the GP shortage - no, it's not only people if rural communities who are having problems finding Doctors. The doctor shortage in the National Capital Region where I live now is quite severe. It may not look that way when you go the College of Physicians and Sugeons of Ontario site, but when you start calling those listed as "accepting patients" they are either immeidately out of medical school, under some restriction from the college, or only accept people on a walk-in clinic basis. And even then the list is very, very short.

That being said, it's nowhere near the doom-and-gloom suggested by the detrators either.

I guess, in general, I wish they compared the US system to those overseas more often and less to Canada's. Similarly, we need to stop comparing ourselves to the lousy system in the States and saying we're proud-- we should be striving to provide services on par with the best, not just better than the worst.

L-girl said...

I am a staunch supporter of the Canadian system, but I do find that most of the defenders of the system, such as Sara Robinson, intentionally play down the problems with the system and make the system out to be much better than it is.

Did you read her post? I don't think she does that at all.

A great example is the GP shortage

She addresses that, in a way very similar to what you've written here.

Scott M. said...

I did read her post in it's entirety. She says it's true it's hard to find for a few, and goes on to say it's difficult for those in the territories and in small towns.

I've lived in:
Oshawa
Orono
Kingston
Toronto
Newmarket
Keswick
Ottawa

The only place where I didn't have to struggle to get a family doctor is Toronto. In fact, I kept my Toronto doctor for years waiting for one closer to Newmarket, then Keswick.

I believe the stat is around 5 Million Canadians don't have a family doctor. Yes, it's better than the US, but that's still 1/6th of the population who have to rely on walk-ins and the hospital. I don't buy the "something [walk-ins, emerg] is better than nothing" argument for why our system is better-- the GP shortage is unacceptable, and it by no means is limited to small towns and the territories.

L-girl said...

Scott, I understand what you're saying.

Everyone told me I'd have huge trouble finding a family doctor in Mississauga, and I found one immediately. Toronto is supposed to be the hardest place to find a family doctor (at least that's what I've read and heard many times), but as you've said, you had no problem. So obviously it varies.

I think the walk-in system is excellent. There is always a doctor available, without clogging up emergency rooms with non-emergent cases, and it's always free. If anything like that existed in the states, it would be beyond awesome.

Of course there are flaws in the Canadian system. But as Sara Robinson said in the comments of that post: "You are complaining about stopped drains, faulty wiring, and leaky roofs in front of people who are living full-time under an underpass because they have no hope of ever owning a house."

Her post isn't written for Canadians to tell them there's nothing wrong with the system. It's written for Americans to tell them that universal health insurance is possible, and to counteract the complete lies and utter bullshit they hear daily about health care in Canada.

ss said...

That was a great article! Thanks for sharing. My hubby and I are planning to move to Toronto before the end of the year. He's Canadian, so I'm very lucky! I've tried to talk to my mom about why were moving. There a lot of obvious reasons - political atmosphere, healthcare, lower crime rates, etc... My mom actually said, "Yeah, but I heard they pay about 70% in taxes!". I mean...really? I was floored. Then I started to tell her a little about the healthcare system and she said, "Well, Canada is going to go in debt for that. And, you can't even choose your own doctor and you might not even be able to get care because you're going to have to wait." Wow. Someone did a good job brainwashing the American public. Surprise. So I forwarded her this article and eagerly await her response...

L-girl said...

Someone did a good job brainwashing the American public.

Well said!

I used to keep track of stories about the Canadian health care system in the (supposedly liberal) NY Times. I did this for 3 years. 100% of the stories were negative. I don't mean slightly negative, I mean outright lying, bashing negative.

70% tax rate??? How could anyone live? If it's any help to you in your discussions with your mom, we pay the same taxes as we did in NYC. Only here we have a lot more to show for it!

I'm glad this post was helpful to you, ss. Please get in touch once you're up here!

ss said...

Thanks for the response L-girl. That's so interesting about your NY Times experiment. It never ceases to amaze me how the media can print outright lies and wrongly influence the masses.

BTW, I've been reading your blog for a little while now and really love it. Would love to get in touch when we make the move. We are SO ready!

L-girl said...

ss, thank you so much!

If you make the move before June, I hope you'll come to "wmtc3," our third annual backyard bash. Turnout should be very good this year. I want to make it a fundraiser for the war resisters.

In any case, email me before you move! Good luck with everything.

redsock said...

I used to keep track of stories about the Canadian health care system in the (supposedly liberal) NY Times. I did this for 3 years. 100% of the stories were negative. I don't mean slightly negative, I mean outright lying, bashing negative.

Which means every word they print on another subject (take your pick!) might also be 100% wrong.

ErinOrtlund said...

Thanks for the link! I have posted it to my blog as well. Is that true that Canadians pay only 10% more in taxes than Americans? I would have thought it was greater than that.

L-girl said...

Thank you Erin!

Is that true that Canadians pay only 10% more in taxes than Americans?

I think that's an average. It depends on where you live and how much you earn.

Canadians in the highest tax brackets do pay higher taxes than their American counterparts.

Our taxes stayed the same after moving, because NYC and NY State have high taxes. People from US states with low taxes (and crappy services) pay less.

But of course, when you figure in the cost of health care - either out-of-pocket, or through premiums and co-pays Americans with insurance - how do the costs balance out?

Tom said...

The best thing I can say about the Canadian health care system is to give a story of my most recent use of it. (warning: some ickyness to follow)

Last June, I was taking out the recycling one night when I tripped. When I hit the ground, my hand landed inside the recycling box. My index finger hit a piece of waxed cardboard at just the right angle and force to drive a shard of it underneath my fingernail all the way to the quick, about a centimeter/half inch deep. Painful does not begin to describe this.

However, this is a non-life threatening injury. According to some folks south of the border, I should have spent several weeks waiting to see a doctor, right?

Wrong.

After rapping a bandage around the finger to keep everything together, I drove to the hospital. I went to Emergency, saw the admitting nurse and the triage nurse, was sent to the minor surgery ward, saw a doctor who removed the bandage, numbed my finger, removed the shard from under my nail, wrapped my finger up in gauze and sent me on my way.

Total time: about an hour.
Total cost: Zero.

In the US, what would this have cost me, and how long would it have taken?

L-girl said...

OUCH! Tom, I'm glad your finger is ok!

Our experiences so far have been 100% positive, as have those of other US-to-Canada folks we know. Those experiences include a hysterectomy, a hernia and a slight head injury. And of course my own for chronic conditions.

The wonder of it is that so many Americans feel compelled to trash the Canadian system and defend the US's "system", despite all evidence. It's true they are brainwashed about Canada, but why defend the US's non-system when it's clearly not working?

Tom said...

Thanks l-girl

Finger's fine, but took a couple of months for the new nail to grow back.

BTW, I've just finished reading your blog. Took me two weeks, but like any story, you've got to start at the begining.

Have you had a chance to read more of Pierre Berton's works? If you haven't, I strongly recommend 'The Great Depression' It'll amaze you just how far to the right this country used to be, and the conditions that lead to the creation of the CCF (predecessor of the NDP)

L-girl said...

BTW, I've just finished reading your blog. Took me two weeks, but like any story, you've got to start at the begining.

Wait a sec... You are not Tom of Canadian Hope. You are Tom of...?

Thank you for going back and reading all that. I'm honoured, really.

Have you had a chance to read more of Pierre Berton's works?

I'm working my way through. :) I'll get to most of them, eventually.

If you haven't, I strongly recommend 'The Great Depression' It'll amaze you just how far to the right this country used to be, and the conditions that lead to the creation of the CCF (predecessor of the NDP)

Thanks for the recommend, I'll definitely read it. But no, it won't surprise me. I've come too far with the history already for that!

deang said...

Commenting on regional shortages of rural GPs, Robinson says:

and in America, the government won't cover the airfare for rural folk to come down to the city for needed treatment, which all the provincial plans do.

The fact that this is done is a telling difference between the US and Canadian systems, as it is absolutely unimaginable in the US. On reading it, I was reminded of Michael Moore's facial expression in "Sicko" when he found out that transportation costs to hospital are reimbursed in the UK. In the US, if there are no GPs locally and you don't have the money to travel to a distant GP, you probably just have to remain sick. And, of course, even if you can afford the costs of travel and have insurance, your insurance company may not cover the costs and will in fact try hard to deny you coverage even if you've been making monthly payments for years. Aaaahhhh!

SoSock said...

Health Care
A subject way too close to me at this time.
My wife and I are trying to get small groups together to watch Sicko. We ordered a copy when it was first released.
How in the hell ANYONE can defend the system we have here now is beyond believable. I understand the reality that profit is the driving force that makes the world go around, but how on earth are the victims of this system so easily suckered into believing it can only get worse if we change it?
Just like the situation with Bush's war - fear-mongering
If you change it you won't have any choice.
They're trying to deny you your freedom of choice.
They're going to make decisions for you.
It's just the start of the road to socialism in this country.
They're going to raise your taxes and then spend those dollars for you (wait, don't they do that now?)
The level of care you receive will fall to the same level as those poor people. (as opposed to, maybe their level of care will improve)
It really hurts my head.
One of the oddest things is that many of these people are being absolutely SCREWED themselves by the insurance industry, are having their choices dictated by the insurance companies and HMOs, and are having medical decisions about their welfare made by a big bureaucracy. They put their money, lots of it, into this system every month and then let the overseers of that system decide what to do wit it. (sound familiar?) They are also very much in danger of suddenly discovering that they don't have the coverage they have assumed is there for them. They are very likely to find themselves in need of this same system that they are so opposed to, even though they are "responsible" people who can afford and think they have "adequate coverage".
And yet... it can't possibly be a good system if the government is involved?
OK, how about we dismantle the military then? Go out and hire your own militia. You can't possibly support giving more money to this government-run universal dfense system, can you?
What if you don't get to choose which country is invaded using your tax dollars?
Holy Shit, that's unthinkable. Sounds like a slippery slope to pinko communism to me :>

L-girl said...

SoSock's wife

L-girl said...

but how on earth are the victims of this system so easily suckered into believing it can only get worse if we change it?

That's my question over and over.

(wait, don't they do that now?)

And how they fail to see that. Right now your doctors are chosen for you. Right now your health care is being decided by bureaucrats. Right now your money is being wasted on adminsitrative costs. And you're not even getting health care!

It would be difficult enough to break the grip the insurance industry holds on Congress. But the job is made a million times harder by the willing victims of the scam. So many Americans willing to defend something that is clearly not working - because you can't criticize the USA. It's TGNOTFOTE!

L-girl said...

The fact that this is done is a telling difference between the US and Canadian systems, as it is absolutely unimaginable in the US.

Exactly. Like the walk-in clinics here, which I mentioned in a comment above.

It's supposed to be difficult to find a family doctor in our area. But there are clinics everywhere - all over, with huge signs saying WALK IN CLINIC - where anyone can go without an appointment, and see a doctor, any time, for free.

That is completely unthinkable in the US.

Scott M. said...

Her post isn't written for Canadians to tell them there's nothing wrong with the system.

I certainly understand her audience, but I think it doesn't do her argument any favour when she plays down the problems with our system.

Toronto is supposed to be the hardest place to find a family doctor (at least that's what I've read and heard many times)

Wow. Never heard that. Ever. It may have a higher patient-to-doctor ratio, but it's generally not a place where people can't find a Doctor. They may not be able to get one within walking distance, but there's lots.

Toronto has a large number of ethnic communities who don't use the traditional health care system nearly as much, and the ratio reflects that.

L-girl said...

I certainly understand her audience, but I think it doesn't do her argument any favour when she plays down the problems with our system.

It could be that people from the US don't see these problems the way you do.

Toronto is supposed to be the hardest place to find a family doctor (at least that's what I've read and heard many times)

Wow. Never heard that. Ever.


Well, I've heard it dozens of times. Before we moved, I heard it constantly, and still do from most people I know who live in the city.

What do you think can or should be done about the shortage of family docs?

Scott M. said...

What do you think can or should be done about the shortage of family docs?

Now that is a very good question.

In this situation, I think it's a case of throwing more money at the problem. (I hate saying that).

We need to:

- Put a maximum on the number of patients a GP can claim in a day (my thought would be based on a 10 hour day with 15 minute appointments).
- Substantially increase the fees paid to GPs to ensure that not only is the above revenue neutral, but results in a signifigant increase to their salary.
- Give a 20% bous to any GP willing to work in a designated underserviced area
- Substantially incresase the number of spots available in medical school, even if that means building a new University Centre of Excellence somewhere.
- Require that government subsidies for medical degrees (above undergraduate) be paid back with service in the province they received the subsidies from.
- A fully funded tuition and expenses could be paid back with a promise to work in the province for a minimum 10 years
- If they wish to work for 7.5 years only, they would get a 3/4 subsidy, etc.
- If they choose to work in designated underserviced areas, they could choose either to have the 20% increase in pay, or a commensurate 20% decrease in commitment.

And if you act now, I'll throw in some ginsu knives free of charge.

L-girl said...

That all sounds good. Clearly you've given this a lot of thought.

I read a long story about this once - maybe in The Walrus? not sure - written by a doctor. Her main point was that a lot more has to be done within the profession and in medical schools to educate prospective doctors on what family doctoring actually is. When she was in med school, she thought of family doc'ing as boring and low-status. Now she is one and she finds it very rewarding (professionally) and more challenging than she imagined.

The article also made the point that waiting lists for certain surgical procedures, like hip replacements, aren't easily reduced, because it takes a minimum of 8 years to "create" a surgeon who can perform them - and even then, that's not an experienced surgeon.

L-girl said...

Oh Scott, I meant to ask, are any of those suggestions you listed being done? Are any of them on the horizon?

Scott M. said...

Are any of those suggestions you listed being done? Are any of them on the horizon?

They've all been discussed, in one form or another, for years. A few years ago there was a correction of fees, but it needs to go further still.

What you see more often now is not an effort of the provinces, rather an effort of local communities and health councils to attract doctors. Some places have gone as far as giving the MDs a rent-free, fully equipped office complete with secretary and a free house. But for now it's very piecemeal and most communities can't afford the incentives needed to attract Doctors.

Scott M. said...

The article also made the point that waiting lists for certain surgical procedures, like hip replacements, aren't easily reduced, because it takes a minimum of 8 years to "create" a surgeon who can perform them - and even then, that's not an experienced surgeon.

Often the problems right now are not that we have too few surgeons, rather we have too few nurses or open (working, funded, staffed) operating rooms. The government has been addressing this now.

I don't know if I've mentioned this before, but one of the best things I think the government has done in a long while is the Ontario Wait Times Website. On that website you can see real numbers of how long certain procedures take, such as cataract surgery or MRIs.

And because you can get treatment anywhere you want, if you're willing and able to travel you might be able to have a signifigant difference in wait time.

For instance, for an elective MRI at Humber River Regional Hospital you'll have to wait 236 days. However, if you go to Markham Stoufville Hospital, the wait is only 32 days.

Tip for anyone looking at the site: Search for the treatment in your area. When presented with the results, you'll see a link at the bottom with the "Shortest wait times in the province". Go there instead if you can. :)

L-girl said...

Very interesting, thank you, Scott.

One thing that Canada really needs to improve is speeding up re-credentialing of immigrants. Doctors and nurses certified in their own countries come to Canada, then work in unrelated fields as they negotiate the process of re-certification, which can take years. I know it's important to make sure they meet Canadians standards, but there must be a way to speed that up. It would benefit everyone (both the individual immigrants and the people who would use their services) so much.

Scott M. said...

One thing that Canada really needs to improve is speeding up re-credentialing of immigrants.

Absolutely! It's a farce. That would be one major part of opening up spots in our education system.

L-girl said...

Absolutely! It's a farce.

There's a lot of stuff about this on the internet - people who came to Canada and are angry that they can't find work in their fields.

Scott M. said...

There's a lot of stuff about this on the internet - people who came to Canada and are angry that they can't find work in their fields.

A large part of that is the federal government's fault. They maintain a list of skills that have major shortages in Canada, and try to expedite immigration requests from folks who have that skill. They actively solicit individuals with certain skills, with promises that when they arrive they will be welcomed with open arms.

Of course, the recruiters minimize the effort requried to obtain Canadian credentials from the Doctor's colleges or engineering societies, etc. They try to hit targets.

The unfortunate fact is when these highly skilled people arrive, they find the number of spots available (residencies, etc) to requalify are woefully deficient.

The different levels of government keep talking about improving this, but seem to make only minor adjustments instead of large corrections.

L-girl said...

A large part of that is the federal government's fault.

Absolutely. My own quibble is, are they really *promised* anything? Some of the writing I've seen seems like people thought they could emigrate without risk, as if there was a guarantee of properity and happiness in another land. And that clearly can't ever be the case - there are no guarantees in life, ever.

But I do agree that Canada needs to address this, but does not.

rkalyana said...

I am originally from India and currently living in Canada on a student visa. If I can get my foreign credentials evaluated in USA then can I use that here in Canada to get a work permit?

L-girl said...

Rkalyana, you need to research that with CIC (Canadian Immigration). I don't know the answer, but even if I did, you shouldn't trust what one person on the internet says. You've got to find out the facts for yourself. Go to the website of Citizenship and Immigration Canada (CIC) and read up. Best of luck.